HomeMy WebLinkAboutInsurance Certificate: Valley Slurry Seal
----`ea41 BASIC-1 OP ID: SE
'44C°R° CERTIFICATE OF LIABILITY INSURANCE 0 °310412014
"
03/0
/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER Phone: 650-573-1111 UNEACT Ciselle Bucsit
Andreini 8 Company-San Mateo
License 0208825 Fax: 650)78-4361 uc° N, EX1.650-378.4225 Fa No: 650-3783361
220 West 20th Ave ADDRESS,
San Mateo, CA 94403 SS: cbuesit@andreini.com
-
AndreiniBCompany INSURER(S) AFFORDING COVERAGE NAICA
INSURERA:National Union Fire Ins Co PA 19445
INSURED Valley Slurry Seal Company INSURERB:Starr Indemnity & Liability Co 38318
dba: VSS Emultech INSURER C: Travelers Property Casual 36161
3785 Channel Drive
West Sacramento, CA 95768 INSURER D:
,SURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE AOO POLICY NUMBER MWOYEFF PMrOYEXP LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,06
A X COMMERCIAL GENERAL LIABILITY GL5388220 03101/2014 0310112015 PREMISES Ea occurrence $ 100,00
CLAIMS-MADE Fx-1OCCUR MED EXP (Any one person) $ 10,00
X Deduc$1,000,000 PERSONAL BADVINJURY $ 2,000,00
X OCIP Excluded GENERAL AGGREGATE $ 4,000,00
GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP/OP AGG $ 4,000,00
,,T F
POLICY X PRO LOC $
AUTOMOBILE LIABILITY COEMMBINdDEDI R-21' SINGLE LIMIT 00,00
A X ANY AUTO CA5101610 0310112014 03/0112015 BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY(Par accident) AUTOS NONOOWNED PROPERTYDAIIA
GE HIRED AUTOS AUTOS Per accidenX Ddac $1mm X OCIP Exclu MCS 90 clude
UMBRELLA LIAR X OCCUR EACH OCCURRENCE 00,00
B X EXCESS LUIB CLAIMSMADE 1000020753 03/01/2014 03/0112015 AGGREGATE 00,00
DED RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' 1JABILRY
ANY PROPRIETORMARTNERIEXECUTNE Y❑ NIA PERMISSIVELY SELF INSD E.L. EACH ACCIDENT $
OFFICER~JEMBER EXCLUDED?
(Mandatory in NH) CERTIFICATE #2106 E. L. DISEASE-EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS W. E.L. DISEASE -POLICY LIMIT t
C Leased/Rented Equi QT6307444L337TIL14 03101/2014 0310112015 Bikt Lmt 750,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N mare apace Is required)
CERTIFICATE HOLDER CANCELLATION
ASHASHI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Drive
Ashland, OR 97520 AUTHORQED REPRESENTATIVE
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD